Hormonally yours… A Transgender Person’s Adventures in Endocrinology

I have always been deeply suspicious of people who claim to be changing sex because they feel “like a woman trapped inside a man’s body” (or vice versa).  With a woefully underdeveloped concept of what it means to be a woman – or a man, for that matter – I have long been incapable of articulating what, precisely, are the emotional and psychological differences between the sexes, and, consequently, highly sceptical of anyone who claimed they ‘felt’ like a member of the gender to which they were not assigned at birth.  I was just… me, I thought, not a set of variables within a biologically determined category allotted a prescriptive set of parameters regarding how I should think and behave.  Transition, by implication, couldn’t possibly be a process of setting free one’s inner-male or inner-female, I reasoned, because it was more a question of redefining my social space, not my interior life; an endeavour to shape a male or female identity from the outside in, not the inside out.  After two months of taking the testosterone-inhibiting drug, Diphereline, however, I’m no longer as sure as I was about whether it is biology or environment that maketh man or woman…

 

I started taking oestrogen because of the minor cosmetic adjustments I had been assured it would trigger.  I was told I would notice some redistribution of fat – a tendency to gain weight on the hips rather than the belly, for example – and that I should look forward to enjoying a full head of hair for a good while longer than presaged by my father’s youthful baldness.  A couple of months in to the treatment, I was told that my face had changed; that my previous jowly plumpness had disappeared to expose my cheekbones.  Changes to the way hair grew on my body were also promised, but, as I was also following a strict regime of depilation, it was difficult to tell exactly how much of my tonsorial success could be attributed to the hormones I was on.

Before commencing the treatment, I was also cautioned to expect a significant change in my emotional state.  I would be prone to mood swings, I was warned, as well as a tendency to take criticism and slights to my character very personally.  I was highly sceptical of that prediction, however, and I still believe I was right to be so: I did not experience any shifts in the way I reacted to emotional stimuli that were conspicuous to me (apart, perhaps, from an irrational anxiety that oestrogen would be unavailable when it was time to stock up again).

From inside one’s own skin, it is rarely possible to be sensitive to the changes taking place on the surface.  I’ve never been one for staring at my reflection for hours, and, not being a Facebook narcissist, I haven’t compiled a meticulous photo-journal documenting my physical transition.  As a result, I’d be lying if I said I felt I had undergone a miraculous transformation as result of dosing myself regularly with feminising oestrogen.  I’m told the change is pronounced – that I’ve got hips now, and round, peachy buttocks – and that the old me has long since vanished, but I find it very difficult to trust the assurances of others.  I worry that people are only telling me what they think I want to hear, and I’m aware that the hormone medication I have been taking is not deigned to help male-to-female transsexuals to look and feel more feminine, but to ease the symptoms of the menopause.  That knowledge makes me dubious of the power of oestrogen to affect physical transfiguration, and I occasionally wonder whether I’ve been prescribed a placebo, intended to satisfy my need to feel as if I’m doing all I can to continue and maintain my transition, rather than a metamorphosing wonder-drug.  I never, for example, enjoyed the glorious burst of breast growth augured in internet chatrooms on the subject of hormone therapy.  For that, it was necessary to seek a surgical solution.

Frame Sweets
The obligatory photograph of some generic medication, which tradition dictates must accompany any article about prescription drugs

For these reasons, being prescribed feminising hormones seemed to me a symbolic, rather than a physiological, victory.  The reason I felt this way predated my application for medical assistance to continue my transition.  The cultural milieu of twenty-first century, western, capitalist life means that a person cannot simply decide to dress and behave in a way contrary to stereotypical expectations of gender and still expect to journey unmolested through everyday public and professional life.  When you finally pluck up the courage to make the switch, a number of significant social and bureaucratic barriers are immediately erected in your way.  There is the painstaking process of informing family, friends and colleagues, for a start, with all the diplomatic wrangling this entails.  Then there is the need to subject oneself to counselling before permission for any sort of surgery or medication can be considered – irrespective of whether one goes private, or joins the queue for NHS support.  Some of these obstacles, the individual can legislate for; others depend on the munificence of key medical, legal and professional gatekeepers.  For example, I can demand the agreement of my boss for me to attend work in my new gender role, but I cannot control the effect this may have on my prospects of promotion.

By the time I approached my GP to request a course of oestrogen (and later, for approval for breast augmentation that I was paying for myself), I had already started living in female role in every area of my life except one (work); dabbled in private health care as far as my budget would allow; and applied to change the name in my passport.  Consequently, I was able to smile, look my doctor confidently in the eye, and ask as casually as if I needed help sleeping for them to put me on oestrogen patches.  To my immense relief (I felt much less sure of myself than I was able to pretend), the doctor simply shrugged and sent me away with a prescription.

I would say that I was lucky in finding a GP willing to prescribe HRT so blithely, but the pattern has repeated itself often enough now – and in more than one country – that I have started to take much of my own credit for the ease with which I have found help to transition.  I think that the reason I have been able to obtain what I want from medical professionals with only a minimum of fuss and the most token amount of jumping through hoops lies in the way I have conducted myself during key gatekeeping meetings.  With the sole exception of my first appointment at the Charing Cross Gender Identity Clinic in Hammersmith, I have appeared calm, measured, courteous, rational, and, above all, sure of what I want.  In turn, the doctors I have met have treated me exactly as they should: as a person in full possession of their faculties who is merely exercising their right to put in, stick on, cut off, and turn inside out whatever they like of their own body.  We are able to claim ownership of very little in our lives, but if we can rightly claim that something (anything!) truly does belong to us, it is the meat that hangs from our bones.  It is an outrage that a transgender person requires the permission of a psychologist before they can exercise that right, and heart-breaking that some transsexuals are so afraid of rejection by medical professionals that they resort to the dangerous on-line black-market of untested and unverified substances.

Frame Meat
We are able to claim ownership of very little in our lives, but if we can rightly claim that anything truly does belong to us, then it is the meat that hangs from our bones

An individual’s ability to get what they want depends on patience, doggedness, and, ultimately, on being in the right place at the right time.  Through just such serendipity, I have recently been taken on as a science project by a family doctor who lives in the same apartment block as me in a south-west suburb of Bucharest.  As luck would have it, that doctor’s specialism is endocrinology.  She was stunned to learn that I was relying solely on oestrogen patches to tinker with my hormones.  This, she said, was like subjecting myself to the emotional rollercoaster of permanent menstrual tension; that having oestrogen swimming around my system as freely as testosterone was positively sadomasochistic, and was leaving my brain utterly bewildered as to which set of emotional precepts should be allowed to dominate.  My brain, in short, was both male and female, and probably didn’t know if it was coming or going.

Accordingly, my doctor/neighbour wrote me a prescription for the intravenous testosterone-blocker, Diphereline, and I have now been taking it – in conjunction with a reduced dose of oestrogen – for three months.  And, suddenly and unexpectedly, I find myself revising my original conviction that what differentiates feeling like a man and feeling like a woman is spurious and unknowable.  I now cry at the drop of hat – and sober up just as instantly.  I have become hopeless in an argument: whereas I once prided myself on my patient, smart-alecky ability to listen humbly to someone else’s point of view before demolishing it completely with a poetic tirade of perspicacious verbiage, I now crumple before the determination of other people to assert themselves, and can do nothing but whine and sulk during a row because I’m not getting my way.

The most alarming change to my emotional and psychological state, however, has occurred in the bedroom.  Whilst I remain sexually attracted to women (at least, I assume, for the time being), the sort of treatment I want between the sheets has altered.  I want to be held, I realise; wrapped in the protective arms of someone bigger and more powerful than me.  I want to be clubbed over the head and dragged into the boudoir by my hair, and then have things done to me whilst I meekly submit to a more dominant partner.  I have become simultaneously very demanding and very lazy when it comes to having my physical desires satiated, and I have become almost incapable of successfully initiating a bout of horizontal gymnastics.  The trouble is, of course, that that is precisely how (with only a handful of exceptions) heterosexual women wish to be treated in the bedroom department, and so finding a compatible playmate is proving very difficult indeed.

Man!  I feel like a woman!  Shania: I think I know what you mean; it’s made me a gibbering wreck, and I wouldn’t change it for worlds.

 

Psycho-sexually Frustrated – Four Case Studies about the Role of Sex in Gender Transition

The psychologist Ray Milton Blanchard gained his PhD from the University of Illinois in 1973.  His post-doctoral research looked at the clinical castration of sex offenders, which led him to join the Clark Institute for Addiction and Mental Health in Ontario, before he became their head of Clinical Sexology Services in 1995.  Whilst Blanchard’s name may not exactly be a household one, at the age of 71, he’s still kicking, and currently serves on the American Psychiatric Association’s Subcommittee for Gender Identity Disorders.

Blanchard’s 1989 theory on transsexuality posits that male-to-female transsexuals can be categorised neatly in two distinct groups.  The first, the ‘homosexual transsexuals’, are individuals who are sexually attracted to men – particularly heterosexual men – so homosexual transsexuals seek to acquire a female body in order to be able to appeal to the objects of their desire.  The second group – ‘heterosexual fetishistic transvestites’ – are heterosexual men who seek to become the object of their own sexual attraction; men who find women so alluring that they wish to imitate them completely.  Heterosexual fetishistic transvestites, Blanchard argues, are men who gain a sexual thrill from the thought of being women, and, to describe them, Blanchard coined the term ‘autogynephilic’; which is a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman”.

Blanchard further maintains that there are four types of autogynephiliac.  Transvestic autogynephiliacs are aroused by the act (or fantasy) of wearing female clothing, while behavioural autogynephilia is arousal from the act of performing actions generally regarded as feminine (such as household chores, depilation, or putting on make-up).  Physiological autogynephilia, meanwhile, is the achievement of arousal by fantasising about feminine bodily functions, and anatomic autogynephiliacs get their kicks by possessing (or dreaming of possessing) all – or parts of – a normative woman’s body.

Blanchard’s views may be alarming to those who cling to the notion that being transgender is a more transcendent, spiritual condition than simply getting one’s rocks off wearing fishnets and a belted mackintosh, but he cannot be accused of being illiberal.  He is, notably, a proponent of state-funded gender reassignment surgery – although his primary reason for holding this opinion is that he considers sex-change operations an appropriate palliative for the psychological suffering endured by many transgender people.  In other words, in Blanchard’s view, surgery for transsexuals is as worthy of government funding as any other form of mental health treatment for any other kind of patient.

Such theorising may be grist to the ideological mill of trans-exclusionary radical feminists, but I can’t shake the suspicion that objection to Blanchard’s typology is based on a hope that it isn’t true rather than a conviction that it isn’t.  No-one likes having their lifestyle choices and ambitions – and the huge sacrifices made to fulfil them – reduced to a base, atavistic drive.  Thus, I would like to offer four short tales of psychoanalysis that I think strongly support Blanchard’s assertion that gender nonconformity (particularly amongst non-homosexual men) is an issue of misplaced sexuality and malfunctioning self-esteem, rather than a noble decision to pursue a social and sartorial third way.

(The curious can have a gander at Blanchard’s arguments in favour of publicly funded gender reassignment surgery, here… http://individual.utoronto.ca/james_cantor/index_files/Blanchard2000.pdf)

Frame Blanchard and Teacher
The young Ray Milton Blanchard delighted his teachers by announcing, at a tender age, his intention to grow up to become a sexologist

Case Study One: M. at the Dubrovnik Swimming Pool

I guess I would have been about eleven or twelve when my parents took me on holiday to this resort on the Adriatic.  I can’t remember the name of the town where we went, but I know it was a few miles up the coast from Dubrovnik, so I’ve always thought of that as my Dubrovnik trip.  Most of the holiday is just a blur now – I can’t even say for sure how long we stayed there – but I know it must have been during the summer, because that’s when we always went away as a family.  I know that it was a pretty disappointing holiday, too, and that my parents blamed me for it.  We usually spent our August fortnight in Cornwall, and I had nagged my parents to take me on a foreign holiday because that’s what I thought all my schoolfriends did.  My mother didn’t want to fly, I know that much, so it must have taken quite an effort of will to get her on the aeroplane and put her life in the hands of the pilot and the engineers who had built the 7-3-7.  When the Dubrovnik trip turned out to be such a crushing anti-climax – after weeks of excitement that I was finally going to spend a holiday somewhere other than on the M5 – my mum and dad had yet another reason for giving me their weary, I-told-you-so looks.

The only clear memory I have of the trip (apart from that my parents had wasted their money on account of my keeping-up-with-the-Joneses response to playground peer-pressure), was the afternoon we spent at an open-air swimming pool with a wave machine and water chutes.  The complex was called Poseidon, and probably covered about sixty acres.  There were areas with tables and bars, and others with sun-loungers and parasols.  Once my parents were installed a one of these, and my mum had had a bit of a swim and settled down with a paperback while my dad nodded off in the sun, I wandered off to explore.  I spent time idling in a jacuzzi, and then found a shallow little pool for toddlers that was heated to pleasantly volcanic temperatures.  I got thrown out of that by a lifeguard for being too old when I tried swimming along the bottom, so I made my way to the water-slides.

There were two slides, and they started at the top of a tall tower at the centre of the park.  The tower had flights of wooden steps on the inside to reach the platform at the top.  The blue-painted handrails were rusty and the steps were slimy with mildew, and the queues were interminable.  Dozens – maybe a hundred – holidaymakers waited in line on those flights of stairs, rejoicing when they reached a ninety-degree turn on the staircase because it meant a slight change of scenery.  Once you reached the top, you were helped into the mouth of whichever slide you chose by one of the lifeguards, but then you were held in suspense by one of them placing a sinewy, sunburnt leg in front of you across the fibreglass halfpipe.  When the lifeguard judged the previous thrill-seeker was safely out of the way, he would lift his leg, and you were carried away by the rush of water.

I had ridden (and queued for) the slides maybe a dozen times, and was waiting on the final flight of steps just before emerging from the shadows inside the tower into the sunshine, when I became aware of a sort of ripple passing through the huddles of people below me.  Punters were reluctantly shuffling on the narrow steps to make room for someone who was shouldering their way self-consciously up between them, and making their way to the top.

When the source of the disruption reached the flight of steps where I was standing, I saw that it was a girl.  She was a little bit older than me, but not much – thirteen or fourteen, I reckon.  Her long, black hair was already wet from swimming, and she had smooth, olive skin from, I fancied, spending hours in the Balkan sun.  She was wearing a green, two-piece swimming costume the colour of an avocado.  She had a heart-shaped face, and we made eye-contact, very briefly, as she climbed past me.  She had a sulky, bored-looking expression, and her eyes were wide apart and a very light, almost transparent brown colour, like marbles held up to the sun.

The lifeguards exchanged secretive, knowing looks as the girl passed between them and settled herself at the start of the water-chute nearest to me.  I now realise that she was probably the daughter or something of some bigwig at the waterpark – the owner’s niece, probably – and that she therefore had immunity from the tedium of queuing, and was able to jump straight to the front of the line.  The glances the lifeguards gave each other certainly, I now realise, suggested that they had seen this girl before, and that they were more than familiar with her silent, haughty jumping in line.  I know now that that was what their bemused looks meant, but, at the time, my confused adolescent mind connected this girl’s apparent power and aloofness with the fact that she was slim and pretty.  I wanted what she had; I wanted the same authority to have people move aside for me, and I wanted people to gaze enviously at my trim shoulders and slender legs as I walked past them.  But to have that dominion, I knew I had to be a girl.

At the top of the chute, the girl didn’t turn and look back.  After a few seconds, the lifeguard lifted his leg, and she was gone – borne away down the halfpipe in a plunging churn of water.

Case Study Two: R. Explores Spencer Marsden’s Pornography Collection

During my second year of high school, I formed an unsavoury friendship with a plump, freckled boy in my year called Gavin Marsden.  Marsden had flame-red hair and bulging, thyroidal eyes, and he led me astray in no small measure.  With the basic expedient of peer pressure, he intimidated me, at various times, into playing truant, committing acts of mindless vandalism, and indulging in petty bouts of small-scale shop lifting.  I am in no way proud of my twelve-month association with him.

Marsden’s principal appeal wasn’t his magnetic personality, his double-jointed thumbs, or his ability to belch, to order, phrases of increasing lexical complexity.  It was his step-brother’s compendious assortment of pornography that kept me in thrall to him.  Spencer Marsden was a good decade older than Gavin and me, and his library of grot ranged from the everyday mainstream material of the newsage’s top-shelf, to hours of videotape of eye-popping acts of sexual kink and vulgarity.  In his limited defence, Spencer Marsden didn’t appear to have amassed this impressive Aladdin’s Cave of filth for mere titillation: like Philip Larkin and Kingsley Amis are reputed to have done with the Victorian porn they accumulated, Spencer kept his treasure-trove well catalogued, and padlocked in an impressive oak wardrobe in his bedroom.  To my callow sensibilities, Spencer’s connoisseurship lifted him high above the rank of a mere common-or-garden masturbator, but, unfortunately for him, Gavin and I were soon adept at picking the wardrobe lock, and we skipped school on many afternoons to pore over the collection while Gavin’s family were all at work and the house was empty.

This pornucopia of muck constituted the lion’s share of my adolescent sex education.  In today’s parlance, most of the content was pretty vanilla, but, every now again, Spencer’s library included something a little less middle-of-road.  Gavin and I whiled away hours fast-forwarding through miles of tape for fleshy tableaux to boggle at in amazed awe.  We squinted in disbelief at vaginas stretched to accommodate dildos the size of saxophones.  We gasped in horror at a woman fellating a donkey with a West Country accent.  We winced in revulsion at the squatting coprophiliacs performing with alacrity at the Glass-Topped Coffee Table Club.

I realise, looking back, that some of the X-rated imagery I witnessed left me with deep, irreparable scars, and, as a young adult, I fretted for years over the psychological damage watching Down on the Farm must have done me.  (I was granted some emotional solace years later by a random encounter with a friend of a friend at a party, who told me, “To be haunted by images of men violating chickens and woman being serviced by horses is a good thing.  The time to worry is when you find yourself thinking, Where can I get my hands on more of this stuff?”  God bless him, whoever he was: he restored to me tremendous peace of mind.)

But it would be impossible to fully exorcise the troubling memories of every fifth-generation grumble epic that flickered before our adolescent eyes in those afternoons in the front room of Gavin Marsden’s parents’ house with the curtains drawn.  My psyche will never be completely purged of some of the things I saw, but what all these startling masterpieces had in common – to my impressionable eyes, anyway – was that the women seemed to be the ones having all the fun.  That is not to say the men (when they appeared) didn’t appear to be enjoying themselves, but it was the women who always had the interesting toys; or had food mashed into their bodies; or had bendy things inserted into them; or had two or three (or more) men attending thoroughly and diligently to their every sensual need at once; or (and this is perhaps the most important and relevant observation about the whole, clandestine, year-long experience) who wore the sexy costumes.  The women seemed to be deriving all the pleasure, I deduced, whilst the men were doing all the hard work.  If ever I were to appear in a naughty movie, I decided, it would be in one of the women’s roles, and in one of those beautiful costumes of lace and silk and corsetry and garters.

Spencer Marden’s pornography collection probably did me deeper, more complex and more lasting damage than over-exposure to adult entertainment does most individuals.  Even now, when I watch porn as one of the worldly-wise, I don’t imagine myself doing things to the female performers.  Instead, I imagine myself as one of the female stars, having those things done to me.  Did my crossdressing blossom as a consequence of seeing the submissive, accelerated enjoyment of sex (with all the fabulously fussy outfits) the women appeared to be having in the movies in Spencer Marsden’s archive?  At that vulnerable age, how else was I supposed to connect the dots between the clothes and the women and the attention and the pleasure in those films?  Of course I wanted those ecstatic experiences or being worshipped and attended to for myself; of course I did.

Frame Treasure Chest
The Box of Delights – you never forget your first encounter with pornography

Case Study Three: J.’s White-Trouser Rejection

When I think of the sort of thirteen-year old I was – mawkish, awkward, pathologically unfashionable, no discernible taste in music, capped with a pudding-bowl haircut like a minor character in a Billy Bunter story – it doesn’t surprise me in the least that none of the girls at school fancied me, but that didn’t stop me wanting a girlfriend more than anything else in the world.

I had that uncanny capacity, too, of being able to oscillate wildly from pudgily overweight to very skinny, so that my blazer and school trousers either hung off me like bags, or barely met at the zip.  This capacity for rapid and dramatic weight loss and gain was, I suspect, a symptom of the bouts of depression I suffered during puberty.  I wasn’t able to diagnose myself at the time – nor to connect my mental state to the ebb and flow of my waistline – but I certainly spent a great deal of time as an adolescent crying, and, on those occasions when I did attempt to confide in my mother, complaining to her that I was ugly.

The thing I blamed for these periods of misery, of course, was my inability to get a girlfriend.  Unfortunately, being such a spaz (to use a moniker that was all the rage back then) meant that I didn’t handle rejection gracefully, or particularly philosophically.  Instead of taking a long, hard look at myself and attempting to replicate the things my contemporaries did who had more success with the ladies, I elected to play the averages game, reasoning that, if I threw myself at enough hapless females, one of them would eventually cave in and say yes.  Sadly, however, it didn’t work out that way, and, the more clumsy proposals I made, the more rejections I racked up.  Or, to put it another way: my conversion-rate of propositions to rebuffals remained constant at a perfect one-hundred percent.

On top of my increasing desperation, I realise with hindsight that I was granting the girls at my school more and more power over me.  In fact, I started to assume that their power over me had been earned for no other reason than that they were girls, and that it must be a marvellous thing to be female, because, that way, you had boys simply hurling themselves at you, and you could take your pick without any thought for the broken corpses of unrequited suitors littering your wake.  To my mind, you see, I wasn’t giving girls power over me: they had pre-eminence for no other reason than that they had nice hair, no hair on their legs, and could wear pleated skirts and shoes with buckles on them.

To make matters worse, my mother’s advice on the subject was always jaw-droppingly inadequate.  The most telling example of this happened while we were on holiday that summer on a campsite of static caravans near Scarborough.  Overall, I think I’d been enjoying the holiday up until the night I’m going to tell you about.  There was an amusement arcade on the campsite, and plenty of other things to keep me amused: trampolines, a pool, and it was possible to hire bicycles for the afternoon, and I idled away hours in my own company while my younger brother and my parents did whatever it was they did to pass the time back at the caravan.

The campsite had a clubhouse with two distinct areas.  In one room, there was bingo, stand-up comedy, a bar, and general adult entertainment; and, in the other, there was a disco for under-eighteens to keep them out of their parents’ hair for the evening.  Not being big drinkers, however, my mum and dad seemed quite happy to hang around the children’s disco with my brother and me, smiling benignly from their table as my brother drifted off with the new friends he’d made and I pleaded for a ten-pence piece to go and play another round of Space Invaders in the arcade next door.

Having put the best part of two pounds into the Space Invaders machine, I was sitting disconsolately with my parents when my mum leaned over to me so I could hear her over the sound of Agadoo.  She told me that a pretty, blonde-haired girl on the dancefloor had been staring at me.  This seemed unlikely – and I was right to be dubious – but I asked my mother how she knew anyway.  By way of explanation, she simply said that the girl had been hanging around by the edge of the dancefloor to get my attention, and that I should go and ask her to dance.

I wasn’t convinced.  Every instinct in my body (raw from the memory of the long list of rejections from the girls at school) screamed that my mother was wrong; that it was mere coincidence that the girl had been looking my way.  We were sitting quite near the door, and it was very possible that the girl had just been squinting through the flashing neon to see where her own mother and father were.  Deep down, I knew my mother was mistaken, and that to listen to her would only invite disappointment and humiliation, but, with the wretched credulity of perennially desperate, I stood up and made my way to the dancefloor, braced to ask the pretty blonde if she would stand facing me from two feet away, and watch while I gracelessly leaned from one foot to the other with my fists clenched and arms bent at the elbows like I might punch someone in the stomach, and while I wore a pained and embarrassed expression like someone ordered to fake enthusiasm with a gun held against their head (or ‘dance with me’, as I liked to call it at the time).

A period of about seven or eight minutes passed before the girl offered me a weak smile and walked away, but, as she hadn’t actually laughed at me or burst into tears, I considered my preliminary advances something of a success.  I couldn’t wait to go back to the caravan and wallow in my victory, and I was still so pleased with myself the following morning that, over breakfast, I allowed my parents to persuade me to undergo something of a makeover.  I needed to ditch the corduroy, they said, and get some jeans.  And not just jeans: white jeans, no less, with high-top trainers, and a tie-died tee-shirt to top off the ensemble.

So: they took me into Scarborough and kitted me out like a prize dickhead, and I was so stoked by the afterglow of the previous night’s conquest, that I allowed them to.  I was more than an innocent bystander: I was a willing accomplice to my own disgrace, and, as my dad had a shave and we got ready to retire to the clubhouse that evening, I even used my mother’s hand mirror while I applied a generous dollop of hair gel to my unfashionably utilitarian locks.  I like to think I still had possession of sufficient wherewithal not to wear a medallion with a silver-plated marijuana leaf on it, but I have the awful feeling that I pulled such an item of jewellery over my head nonetheless.

You can’t gild a turd.  It takes a certain je n’ais c’est quoi to pull off white jeans, high-top trainers and a tie-dyed tee-shirt, and I just didn’t have what it took.  No amount of hair gel could compensate for the self-conscious slope of my shoulders or my tarmac-gazing, pigeon-toed gait, and I went into the clubhouse that night like a lamb to the slaughter.

When I eventually found the pretty blonde-haired girl and tried to reacquaint her with who I was (“Hello.  I’m the inverse Cinderella!  We danced last night, when I looked more like a ‘Last of the Summer Wine’ tribute act and less like a sex offender…”), she goggled at me in wide-eyed horror for a few seconds, and dashed over to a group of boys my age who were hanging around the Slush Puppy machine.  When she had reached the relative safety of her peers, I was acutely aware that the slow, dawning turning of their attention onto me meant that she was telling them that that nutter from last night was harassing her again, and that they must kill me if I made any further attempt to speak with her.

I watched with petrified ignominy as the group closed ranks around my blonde-haired princess.  I knew the game was up, and that my mortification was complete.  I had gone out and tried to dress myself like the boys I had seen who didn’t stutter like an imbecile when they tried to talk to girls, and those clothes had swallowed me whole.  I had drowned in them.  It was the defining statement, I think, of my relationship with male clothes, and I hated what I had done to myself by attempting to fit them.  Certainly, I was never able to go shopping for clothes after that with any sense of enthusiasm or joy, and I knew, as plainly as I knew that girls had the power to humiliate and hurt me, that I would never, never, listen to the advice of my mother and father again.

Case Study Four: Matty Dresses like a Girl for Hallowe’en

I cannot exaggerate how unexceptional I was at school.  When report-writing season came around, I suspect I was one of those students my teachers had to really think long and hard about before they could remember who I was.  I wasn’t popular; I didn’t excel in any particular subject; and I had no sporting ability whatsoever (and this is, cruelly, the aptitude that is prized above all others in schools – by children as well as their teachers).  I never won a competition; was never chosen to represent the school for anything; I was never invited to the front of the hall during assembly; I never had my work framed and displayed on the wall.  In fact, the most memorable thing about me was that I once wet myself when I’d been sent out of a maths lesson for talking and was too scared to go back inside to ask if I could go to the toilet.  When my classmates were allowed out at the end of class, they could see (and smell) that I was standing at the centre of a broad, pungent circle of urine.

Everyone gets their fifteen minutes of fame, though, and, when I was nine and in the third year, I had mine.  For reasons that escape me, every October my school thought it more appropriate to devote a day of effort and curriculum time to a Hallowe’en costume parade than to marking a more meaningful, less pagan, festival like Diwali or Yom Kippur.  (My school was in a district of Manchester that had quite a large population of Sikhs and Hindus.  Now I’m older and wiser, I often wonder those children felt knowing my school was more interested in witches, zombies and Dracula than it was in the Festival of Lights.)  The last two Hallowe’ens, I had shuffled around in the costume parade with heavy heart.  Some of the kids had parents who took the event very seriously, and they always had great costumes.  They were so good that them winning the parade was always a foregone conclusion, and there was almost no point anyone else making an effort.  (Mark Baxter, for example, usually came as a wizard, and the attention to detail on his costume was always breath-taking.  He had half-moon glasses and a little goatee beard, but the thing that impressed me most was that he had an old hard-back book under his arm that his step-dad had rebound in black paper and painted a pentangle on in Tipp-ex.  I couldn’t compete with that: my parents just didn’t have the imagination.)

It was the girl’s costumes that I envied most, though, and I always wished I had a princess’ gown or a Snow White dress that I could pull out of the wardrobe to fall back on at events such as this: something pretty that I could enjoy wearing without it bothering me that I had no chance of winning.  My fancy-dress options were always so pitifully thin that one year my mum told me to pull one of my arms out of my sleeve and hide it inside my shirt.  I was given a pair of her tights to wear on my head and a cardboard sign on a string to put round my neck with ‘One-armed Bandit’ written on it.  That was how bad things were for me.

This one year, however, I determined not to be miserable on Hallowe’en.  I told my parents I wanted to go the parade as the bearded lady, and my mum couldn’t root out a dress for me fast enough.  My father was a member of the church pantomime society (he usually played the villain because he was quite stocky and had quite a good singing voice), and he had a word with the woman who usually did the make-up and wigs for their performances, and I was booked for a beard fitting with her when my dad was next expected at rehearsals.  My mum lent me a pair of her sandals and a long, dark brown wig she had (and which matched her own actual hair so exactly that I still can’t fathom why she owned it).  The pièce de résistance of the outfit, though, was, without a doubt, the fulsome pair of rubber breasts my older brother had once returned with as a souvenir from a stag-do in Blackpool.

I’d never had any intention of wearing the false beard.  That had been a ruse to get my parents to agree to me wearing a dress for school (and quite a well-chosen one, if I may say so), and I threw it away in the park on my way to school.

When it came time to get ready for the costume parade, my transformation created quite a stir.  Peter Varnavas (who, as well as having a father who owned a fish and chip shop, was – by common consent – the hardest kid in school) was especially captivated by the false breasts.  If I’d worn a dress in public under any other circumstances, Peter Varnavas would undoubtedly have fed me my own teeth, so it was especially gratifying to have won his approval through the simple expedient of rubber tits.  And his reaction proved to be just the tip of the iceberg.  When I appeared in the assembly hall, a buzz went around the room that granted me a celebrity status that was both immediate and spectacular.  When I stood up to sashay up and down before the judges with my class, the crowd went wild, and I will never forget, over the clamour, making eye-contact with Peter Varnavas.  His eyes were wide; he was grinning from ear to ear, and he was cupping his hands in front of his own chest as if holding two imaginary galia melons.  Even through the din of three hundred hyperactive school children, I could hear him shouting, “Push ’em up!  Push ’em up!”

Peter Varnavas is dead now.  He had a boxing coach and was a junior champion, and he suffered a brain haemorrhage during a match when he was sixteen.  But on that afternoon in October when we were both nine, he gave me a gift as intangible as it is impossible to repay.  Along with the student body of my primary school, Peter Varnavas taught me that people pay attention to you if you look like a woman.  If you wear sandals and a nice dress, and if you have long hair and big boobs, people look at you; they cheer you and shout your name; they approve of you and make you exceptional.  If you look pretty, people like you.

Frame Gollywogs
“Come out, come out, wherever you are!” – October 31st has been providing ideal cover for people whose clothing habits lean towards the unconventional for as long as anyone can remember

David Ebershoff’s novel, ‘The Danish Girl’ (2000), tells the story of the life (and marriage) of Lili Elbe – one of the first people ever to undergo sex reassignment surgery.  The passages in Ebershoff’s book detailing Elbe’s first experiences of crossdressing may be coy, but they communicate an undeniable sense of the sensual thrill experienced by Elbe (then called Einar Wegener) when he first posed in women’s clothes for his wife to paint.  Einar began to feel dizzy and warm”, Ebershoff writes when Elbe ascends the model’s podium.  “The yellow shoes looked too dainty to support him, but his feet felt natural arched up, as if he was stretching a long-unused muscle”, Ebershoff continues, before offering the following version of Einar’s emotions as he transforms into Lili:

“A strange feeling was filling Einar as he stood on the lacquer trunk, the sunlight moving across him, the scent of herring in the air.  The dress was loose everywhere except in the sleeves, and he felt warm and submerged, as if dipping into a summer sea.  …the silk was so fine and airy that it felt like a gauze – a balm-soaked gauze lying delicately on healing skin.  Even the embarrassment of standing before his wife began to no longer matter, for… Einar was beginning to enter a shadowy world of dreams where Anna’s dress could belong to anyone, even to him.”

If you overlook the saccharine prose of these passages, there is something in Ebershoff’s fictionalised version of Lili Elbe’s formative crossdressing experiences that every male-to-female transsexual can identify with: the desire to feel attractive and to believe that you look attractive, in the way that women do and women can.

Is this desire sexual in origin?  A more useful question is surely, Does it matter that this desire is sexual in origin?  I would argue that it doesn’t.  It is almost impossible to separate huge numbers of human actions from their sexual motivations, from the way we dress to the way we walk; from the way we interact with others to the language we use and the sort of music we like.  If so much of our behaviour and impulse is already psycho-sexual in nature, then why should it matter that some men want to look the way that millions of women do every day, and why they wish society would treat them accordingly?

The individuals whose stories are told in this article – that is, the autogynephiliacs whose souls are laid bare – have clear and comprehensible reasons for assuming that the power and pleasure they witnessed (and, in one case, experienced) originated from the femininity of the people who wielded and enjoyed it.  While the names and places have been changed to protect the innocent, they are all true stories.  Imagine for a moment, however, that they aren’t the encounters of four separate individuals, but the cumulative vicissitudes of the same person.  That would be intolerable, wouldn’t it?  The individual in question couldn’t be blamed for embracing their new identity rather than attempting to process in another way what happened to them, could they?  These incidents are so closely related to different ways in which boys and girls are treated as children and adolescents – and the role of clothing is so intricately woven through these narratives – that it seems only natural that the participant should seek solace in transition.

What impresses me most about these stories, however, is that they weren’t told to a therapist, or pulled from the mind like a thorn from a foot after hours of psychotherapy.  This self-awareness was achieved through introspection and the patient interrogation of people who care.  These people are far more precious than the professionals who charge by the minute for their willingness to listen.  Therapists are a poor replacement for good friends.

A Visit to Foucault’s Clinic – The West London GIC at Charing Cross Hospital

The West London Gender Identity Clinic at Charing Cross Hospital became part of the National Health Service in 1973, after being founded in 1966 as an informal referral service for transgender people in need of medical support.  There are now eight centres in the UK specialising in gender identity services, but Charing Cross GIC is by far the biggest.  It receives around 1,500 referrals a year from GPs (half of the UK total) – a figure which has been doubling, roughly, every five years.  Its primary function (according to its website) is to co-ordinate the work of surgeons, psychiatrists and endocrinologists in order “to provide holistic care from a biopsychosocial model focusing on the biological/medical, psychological and social aspects of gender”, for people “with issues related to gender, most commonly gender variance associated with gender dysphoria”.

 

Much of the work of the Charing Cross Gender Identity Clinic seems to be geared towards redeeming its terrible reputation.  This reputation is not undeserved, and the clinic itself must accept full responsibility for having earned it.  In 1979, the BBC screened a three-part documentary series entitled ‘A Change of Sex’, which followed transwoman Julia Grant in her quest for gender-reassignment surgery.  In the scenes filmed during Grant’s appointments at the GIC, the psychiatrist assigned to her (John Randell – who died two years after the programme aired) displays an arrogance, condescension and megalomania so horrifying that it is difficult not to believe he is a character-actor, created to demonise all psychotherapists, and to portray the GIC as an uncaring edifice of chillingly Orwellian proportions.

(During Julia Grant’s consultations, Randell delivers a series of schoolmarmish proclamations, with an intonation that rises incredulously at the end of his sentences.  Among his supercilious edicts are the following gems: “It may be that you’re identifying with certain stereotypes of the female gender role, but that doesn’t make you a woman”; and “I’m not prepared to consider any other approach until you’ve done one year as a female… and if you don’t like that, well, then you must find another doctor”; but my personal favourite, when Grant confesses to undergoing breast-augmentation surgery without Randell’s approval, has to be, “I must confess, I take exception to your doing that…  It’s a medical matter: it isn’t a personal choice.  I like to be informed.  You see, once again you’re overstepping the mark, and I don’t like it – not one bit.”)

My first visit to the Charing Cross clinic occurred in June, 2014, when, following referral by my GP, I was invited to a pre-preliminary ante-introductory promotional taster/welcome session.  It was a harmless enough experience: a presentation via PowerPoint, essentially, describing the work of the GIC, the background of its staff, the numbers of patients it saw every year, and a warning (which, because it is included in all their correspondence, I would soon learn by heart) of what would happen if anyone failed to attend their appointments.

After the presentation, the forty-odd people in attendance were invited to share any concerns or questions we might have…  And that is when the mood in the room turned ugly.  I realised that some patients feel quite strongly that they have an axe to grind against the clinic.  The dominant motif of their concerns was the delay in attention they had experienced (consultations scheduled for dates so far in the future that patients couldn’t be sure if they should arrive by taxi or hover-car; appointments cancelled by the clinic without rhyme nor reason, when the patient has already gone to significant trouble to rearrange their own lives around a clandestine trip to London), but it was also evident that many patients felt the primary function of the clinic was to give them psycho-social hoops to jump through before they could complete their transition.

It wasn’t just the theme of patients’ questions that saddened me, however.  It was obvious from the anger in many voices that people had been damaged by aspects of their treatment by clinicians at the GIC.  The shakiness I could hear in their questions – the evident fear that they might burst into tears before they had articulated their frustrations – was a symptom of their dehumanisation as a result of their subjection to what Michel Foucault calls the ‘medical gaze’.  The concept of the medical gaze is developed and placed in its socio-historical context in Foucault’s 1963 book, ‘The Birth of the Clinic’, and it symbolises the separation by clinical professionals of their patients’ bodies from their patients’ identities.  This separation is not merely a medical convenience to facilitate the efficient treatment of disease, Foucault argues, but a product of political forces that form the broader context within which medical practice takes place: the discourse with which disease is discussed and diagnosed is just as much concerned with maintaining hegemonic relationships between the powerful (that is, the educated doctor) and the powerless (the uneducated patient) as it is in other social institutions, such as schools, parliament, prisons, the economy and the church.  In the case of medicine, the balance of power is preserved by ensuring that only medical professionals have access to the decision-making processes of their clinic, and by excluding patients from the discursive practices (and their associated jargon) in which those decisions are made.  The patient is thus reduced to little more than the subject of diagnosis and treatment – the cadaver over which decisions are made – rather than an influential voice in those decisions: medicine (which, in the case of the GIC, would mean access to counselling and voice coaching, the prescription of hormones, and the allocation of surgical resources) is something which is thus done to the patient; not done with them.

The practical upshot of this sociological theorising is that, by presenting myself at the Charing Cross Gender Identity Clinic, I am participating in a discourse in which I am not an equal partner.  If British society determines that gender nonconformity is a deviation from the norm – and that it is a pathologised condition requiring treatment – then the behaviour of specialists at the GIC towards me is, ipso facto, going to reflect that.  Keeping me waiting and ill-informed; condescending to me; assuming I am incapable of deciding for myself what is best for me; withholding access to medicines and surgical procedures until I have fulfilled certain conditions (such as meeting with a psychotherapist); and generally acting as the gatekeepers to my future…  These are all symptoms of a political climate in which I am marginalised, disenfranchised, and made to feel unworthy of the tiny slice of NHS funding I want.

Frame Foucault
Ceci n’est pas une clinique: ‘The Birth of the Clinic’ by Michel Foucault (also available in English)

I had my first appointment with a doctor at the GIC in October, 2014 – eighteen months after my referral by a GP – which meant I’d had plenty of time to study criticisms levelled against the clinic on social media, and to read the clinic’s response to them.  Frustration with the GIC falls into two broad categories, and, accordingly, its rebuttals and ‘myth-busting’ attempts do, too.

Most conspicuously, patients (and potential patients) at Charing Cross complain of agonising delays in being seen, and then of interminable waits for clinical decisions to be made about them.  Appointments made months in advance can be cancelled by the GIC at very short notice, and then (most aggravating of all, it seems) without any reason being given, apart from an airy platitude about how schedules are subject to change.  When cancellations occur, I learned, patients often blame themselves, and fear that they are being discharged by the clinic because they haven’t satisfied all the criteria that have been imposed upon them.  (No such criteria exist in a form that is shared with patients, of course, but when one has turned to the GIC as a last recourse, it must be hard not to be paranoid.)  In its literature, the GIC addresses this criticism only by acknowledging that waiting-times need to improve, but it does not outline how its staff might bring this about.  A delay in attention from the GIC may not seem earth-shattering to anyone who is not frantic for help with issues relating to their gender identity, but it would be a mistake to underestimate how desperate for support some patients are.  If you have been reduced to a state of crippling depression by anxiety over your body and your place in society – and the GIC has become a beacon of hope in an otherwise cruel and uncaring sea – a wait of any duration is a wait too long.

The other main criticism of the GIC is that patients feel demeaned and disempowered by the way staff (from the receptionist to the consultant surgeons) behave towards them.  According to its welcome pack, “a number of false beliefs and misconceptions have arisen” about the professional conduct of staff at Charing Cross.  Some of these beliefs “stem from the way the GIC operated in the past”, whilst others are a result of “the approaches of previous clinicians”, but it is a myth, the handbook asserts, that the Gender Identity Clinic is looking for a particular profile when it chooses which patients it will treat.  Accordingly, potential visitors should not assume that they must already be living in their preferred gender role by the time they attend; be hell-bent on reassignment surgery; have no reservations or doubts about the course of treatment they wish to pursue (and, indeed, what sort of man or woman they wish to become); abandon all other forms of help they might have sought (such as attending a private clinic); nor expect deliberately provocative, aggressive or challenging behaviour from clinicians (staff at the clinic do not “play good cop/bad cop”, apparently).

Whilst the literature produced by the GIC may overtly deny or condemn the dismissive and prejudicial behaviour of its specialists in the past, reports about patients’ experiences on social media suggest that a culture of hectoring and condescension continues at the clinic unabated: the only difference is that is has gone underground.  The Foucauldian belief in the primacy of the doctor’s expertise and knowledge, and the worthlessness of the patients’ wishes and experience, exists in a way that is so insidious – so subconsciously endemic – that clinicians cannot help but allow it to govern their behaviour.  The doctors know best.  Thus, patients report being told that failure to change their passport to reflect their preferred gender role displays a lack of commitment to transition.  Patients who cannot demonstrate a rich and varied social life are considered at risk of spending their existence post-transition friendless and isolated, whilst those who do not have the dietary and exercise regime of an Olympic athlete (or who have the temerity to do something as wicked as smoke) are considered to lack the necessary self-discipline for coping with post-surgical care or a lifetime of taking hormonal medication.  Patients who show signs of depression are assumed to have other issues that need resolving by a therapist before their gender identity can be addressed, and patients who have sought treatment at private clinics are thought to be obsessional, or are accused of being disloyal to the expertise of Charing Cross’ own doctors.

The Gender Identity Clinic addresses a third issue that does not emerge as a concern in the discourse of its critics and patients, namely: people who cancel – or fail to turn up to – appointments.  The numbers of people who do not attend appointments is, according to the GIC handbook, “unprecedented”, and one of the factors “which has contributed to our long waiting-list”.  By placing the blame for delays on patients in this way, the GIC abdicates from its own responsibility for the length of time it takes for a referral to be seen.  Furthermore, the clinic’s guidelines offer no apology for delays, preferring, instead, to threaten patients with sanctions for non-attendance: “if you reschedule three appointments, you will be discharged with no return and will have to seek gender care at another UK GIC”.  The Charing Cross clinic is so omnipotent, in other words, that they can even claim ownership of their patients’ time: ‘We reserve the right to mess you around,’ they are saying; ‘to keep you waiting, and reschedule appointments with neither notice nor explanation, but if you try and do the same to us, we will kick you out.’  John Randell would have been proud of his legacy.

(That said, I find the very notion of not attending an appointment at the GIC difficult to fathom.  Why would anyone – after waiting over twelve months to see a specialist there – wimp out at the last minute?  Unless one has a phobia of being mercilessly patronised, there is nothing to wimp out from: everything at the clinic moves at such a snail’s pace that no-one who visits is at any risk of being rushed or pressurised into a decision they don’t want to make.  I can only assume that the people who do not attend either change their minds entirely about transition; cannot bring themselves to tell their loved-ones what they are up to; have taken matters into their own hands by going private; or have suffered such a catastrophic breakdown that they have ceased to be capable of anything constructive.)

Frame GIC
‘You will never find a more wretched hive of scum and villainy’: a warm welcome from the GIC seems assured when one admires the pleasant, inviting aesthetic of its hallowed, street-side portal

My first meeting with a consultant at the GIC was, after months of anticipation, a spectacular anti-climax.  My employment status was the principal concern of the consultant I saw, along with how my friends and family had responded to (and stuck by me following) my transition.  My hobbies and interests came under scrutiny, too, but, when I mentioned having been a leading-light in my local amateur Gilbert and Sullivan society, I was subjected to line of questioning that was stilted and awkward.   On the surface, the psychologist’s questions seemed designed to engage me in small-talk about Victorian operetta (“What’s the name of the opera that followed ‘The Mikado’?  I know it begins with R, but the name has temporarily slipped my mind…”), but I now realise the veracity of my claims about the activities that occupy my spare time was being tested.  (The answer is ‘Ruddigore’, incidentally, and I didn’t need to pretend that I couldn’t remember it, either.)

I tried to enquire what was meant by the word ‘assessment’ as it is used in the language which describes appointments at Charing Cross.  (Patients are invited to two assessments at the GIC, designed to “reach consensus about the best way forward with your care”, “gain a broader perspective on your situation”, and “help us gain a clear idea of how we can help you”.)  Were there certain indicators the psychologist was looking for? I asked; Was it possible for the clinic to reject a patient on the strength of this interview?; and, Is thirty minutes enough to gain a sufficiently rounded picture of someone to inform a decision that will affect the rest of their life?  I would like to say I received satisfactory answers to these questions.  I would like to say that, but it wouldn’t be true.

Yes, I felt belittled; and, yes, I felt my opinions on my transition and the way I had managed it thus far mattered very little to the consultant who met me…  But was my experience as wholly negative as the ones I had read about?  Not really: I felt vaguely demeaned and thoroughly patronised, but that was about as bad as it got.  My second assessment is in November this year (an epic thirty-six months after my first referral), and, I must admit, any sense I once had that attendance at Charing Cross was an essential step on my transgender journey has completely evaporated.  I no longer feel dependent on the clinic, and I’ve realised that there are alternatives (even for people on a budget) to pleading for the imperious say-so of a GIC doctor for approval for surgery, voice coaching, hormone treatment, and all the more complex, less obvious, aspects of changing the way society views my gender.

As I’ve been waiting for my turn at the clinic, I have learned that I am very unclear about what I want the services of the GIC for.  I am no longer sure the clinic can provide me with anything I am not capable to getting for myself: by communicating clearly and honestly with the people whose help I’ve needed to change my social role, and by working hard to ensure I have continued to present a confident and self-assured face to the world, I have succeeded in transforming myself.  I have found that feminising hormones are relatively easy to obtain with a sympathetic GP, and a therapist – no matter how sympathetic – is no replacement for good friends.  Given that voice coaching is ninety-nine percent down to the amount of work one is prepared to do for oneself, YouTube is as good a place to take lessons as any.  Changing my name and my gender on official documents (like my degree certificate, bank account, passport, driver’s licence, and so on) was just a matter of picking my way, patiently and persistently, through a forest of bureaucracy.  For a fee, I could see an independent specialist (like Dr Richard Curtis at the Transhealth gender clinic in Marylebone), and be treated more like an autonomous human being, capable of making up my own mind about what I do to, and put in, my own body.  When it came to work and hobbies, I discovered that, if I behaved as if the world should continue to treat me with dignity and respect, eventually enough people would – and these people would even begin to compensate for the bigotry and laziness of others.  My attitude to surgery, meanwhile, is something I can only resolve for myself.

By reducing my dependency on the services of the Charing Cross clinic, I have disarmed its ability to intimidate, humiliate, frustrate and disappoint me.  With my newly empowered frame of mind, I can attend my second assessment – not as a quivering vassal of the NHS – but as a discerning consumer, driven by curiosity about what the GIC’s specialists can do for me, rather than what I need to do to satisfy them.

The Gender Identity Clinic at Charing Cross has achieved an unassailable place in UK transgender culture as the only significant institution with the moral and medical right to dispense advice, counselling, support and medication for gender nonconforming people.  Through the discourses of its promotional literature and the conduct of its staff, the clinic has established itself as the ultimate arbiter of gender transition in England.  For all its faults, however, Charing Cross stands as an encouraging symbol of the willingness of the British government to spend time and resources supporting its transgender population.  To become a patient there, however, requires one to accept subjugation to the whim of another; readiness to be condescended to in a way one would never accept in other walks of life; and to dig-in for an interminable wait.  Oh: and to accept that no-one at the GIC ever, ever answers the telephone.

 

An introduction to the services offered by the Charing Cross Gender Identity Clinic can be perused here…                                                                           http://www.wlmht.nhs.uk/wp-content/uploads/2016/04/GIC-patient-information-pack-April-2016.pdf

An excerpt from the dark, tragi-comic BBC documentary, ‘A Change of Sex’ (1979), can be viewed here…                                                                               https://www.youtube.com/watch?v=aeBwniFDDK4

Born This Way – The Neurological Basis of Transsexuality

Given that an impulse to identify with and adopt the signs and symbols of the opposite sex requires exposure to (and imitation of) those signs and symbols, it is tempting to assume that transgenderism is socially conditioned. It is an interesting thought experiment to consider whether someone who was born on a desert island, who grew up with no knowledge of their mother (let’s assume she disappeared immediately after the birth), and who never encountered, read about nor saw pictures of another human being throughout their entire life, could grow up transgender. With no exposure whatsoever to anyone other than themselves (including, obviously, members of the opposite sex), would it be possible for that person to want to change from male to female (or vice versa)? To be (or become) transgender, does one need to experience what the opposite sex looks like, and how it dresses and behaves, in order to identify with it and desire to emulate it? Is concrete experience of something necessary in order for desire of it to flourish? Maybe not, as I found out when I read ‘We Are Our Brains’ by Dick Swaab. Not only is this book chock-full of eye-popping scientific tid-bits you can trot out to impress (or annoy) at dinner parties, it contains a chapter on the neurological bases of transsexualism that may prove that the poet, philosopher and ambulant camel-toe Lady Gaga was absolutely right when she observed, “Whether life’s disabilities left you outcast, bullied or teased/ Rejoice and love yourself today, ’cause baby, you were born this way.”

 

Dick Swaab’s book, ‘We Are Our Brains’ (Penguin, 2014), contains the startling assertion that transsexuality is something we are born with: it is as much a product of our development in the womb as the colour of our eyes or the shape of our feet, and is, crucially, not something that can be changed, ‘treated’ via aversion therapy, or socially conditioned. Swaab was a founding member of the Netherlands Brain Bank – a repository for donor brains that has facilitated work on the mapping and cataloguing of grey matter from a diverse and revealing cross-section of society. Through post-mortem studies of donated brain tissue, Swaab established that, while the differentiation of a foetus’ sex organs occurs in the first half of pregnancy, the development of sex differences in the brain does not take place until towards the end of the second trimester. Because the physical and the neurological development of sexuality occurs at different times in the womb, Swaab thought it was possible for them to happen independently of one another.

In 1995, Swaab’s team published a report in ‘Nature’ of findings that confirmed this hypothesis. The bed nucleus of the stria terminalis (or BST for short – an area of the brain involved in many aspects of sexual behaviour) is twice as large in women than it is in men. Even taking the effects of hormones taken by adult transsexuals into account, Swaab found that the BST of male-to-female transsexuals had a female structure, whilst female-to-male transsexuals had a ‘male’ BST.

Brain
The bed nucleus of the stria terminalis: it’s in there somewhere

In 2008, a group of Stockholm neuro-scientists led by Ivanka Savic were able to study the functioning brain scans of living male-to-female transsexuals who had neither had surgery nor started hormone treatment. During Savic’s experiments, subjects were given male and female pheromones in order to measure the resulting stimulation in their hypothalami. The hypothalamus (amongst other things) regulates the response of the body’s endocrine system to stimuli from the nervous system. (It instructs the pituitary gland to release hormones, in other words.) The effects of pheromones on the brain differs markedly between men and women, and the responses of Savic’s transsexual patients were found to fall between those of non-transgender subjects of both sexes.

The implication of Swaab’s and Savic’s research is that the basis of an individual’s gender identity is neurological, not social. It can be argued, therefore, that our personal sense of our own gender is developmental; that the origins of transgenderism are down to nature rather than nurture, and the role played by environment is in our subsequent construal and enactment of that identity. Swaab further speculates that the neural body map of male-to-female transsexuals lacks a penis, whilst that of female-to-male transsexuals lacks breasts. It is this neural map that gives us a sense of our physical presence and a concept of our physical integrity. Body Identity Integrity Disorder is a syndrome whereby patients become convinced that a part of their body does not belong to them (even though it may function perfectly normally), and they become desperate to get rid of it. In cases of transsexuality, it is possible that, instead of an arm or a leg, subjects do not recognise their penis or breasts as their own, and look for a surgeon willing to remove them.

We Are Our Brains
‘We Are Our Brians’: a coherent and convincing argument for the genetic causes of dyslexia

Coming out is the landmark act of making sure the world around you knows something crucial about you that has heretofore remained secret – or, at the very least, unconfirmed; what TS Eliot might have meant when he wrote “this dedication is for others to read:/ These are private words addressed to you in public.” Coming out isn’t just a rite of passage, though: it is a test of society at large; of the love and understanding of your colleagues, friends and family; of the ability of the world to shift to accommodate you; and of your capacity for finding your own place in communities that might reject you. Coming out requires courage, resilience, patience, and an unerring capacity not to worry what other people think. It increases many people’s affection and respect for you; it alarms and alienates others. It can necessitate enormous sacrifice, but, ultimately, it is the best favour you can ever do yourself.

If you fear that you may be the victim of prejudice at work because someone suspects you have a secret you haven’t told them yet, then coming out is the wisest thing you can do in Europe to gain legal protection from discrimination on the grounds of gender orientation. Under European law, a person becomes transgender when they declare their intention to identify as such, and redress against iniquity is thus enshrined even before an individual has started taking hormones, changed their name on their passport, or begun living full-time in their preferred gender role. A declaration of intent (taken with full appreciation of the consequences of such a declaration) is all it takes for the legal mechanisms of Article 21 of the 2009 Charter of Fundamental Rights of the European Union to safeguard the individual from discrimination by their government and institutions within their country, seizure of their assets and property, and ill-treatment at work, on the grounds of their gender orientation. In order to ensure legal protection in Europe from gender discrimination, therefore, the decision to come out should be made as soon as you’re ready.

If you accept Dick Swaab’s claims about the development of gender identity in the brain, then the act of coming out as transgender is more than a public and ceremonial declaration of self-identification: it’s a diagnosis. It isn’t a transformation as such (although it may feel that way for people who knew the old you): it’s a confirmation and affirmation of a truth that has existed, if Swaab is right, since before you were born.